Provider Demographics
NPI:1942900402
Name:AVILA MORENO, LUIS ENRIQUE (SURGICAL ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ENRIQUE
Last Name:AVILA MORENO
Suffix:
Gender:M
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1870 MARINERS LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-1334
Mailing Address - Country:US
Mailing Address - Phone:786-461-4428
Mailing Address - Fax:
Practice Address - Street 1:2140 W 68TH ST STE 200
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1815
Practice Address - Country:US
Practice Address - Phone:305-822-7227
Practice Address - Fax:305-827-6333
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL20-527246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant